What can replace the anticoagulant Coumadin?
DEAR DRS. DONOHUE AND ROACH: I am a 60-year-old female. I was put on Coumadin because I have intermittent atrial fibrillation. Is it necessary to continue this drug for life? I cannot eat a healthy diet because it interferes with Coumadin. Is there another drug that controls blood clotting without the diet restrictions? -- D.H.
ANSWER: Let's get the Coumadin diet issued cleared up. Coumadin is an anticoagulant, a blood thinner, a blood clot preventer. People with atrial fibrillation tend to form clots in the atria, the upper heart chambers. Therefore, they're put on an anticoagulant in order to stop clots from forming and possibly finding their way to the brain to cause a stroke. Keep in mind that you might not be aware of all the times you have atrial fibrillation. As many as 90 percent of those with recurrent attacks don't know they're having an attack. It can be proven only if these people wear a heart monitor.
Coumadin works by reducing the production of clotting proteins. Vitamin K fosters the production of those clotting factors. If a person on Coumadin eats foods high in the vitamin, that person can overcome Coumadin's action to prevent clots from forming. High vitamin K foods include broccoli, spinach, turnip greens, collards, Brussels sprouts and salad greens. Reasonable amounts are not forbidden; you simply have to be consistent in your daily use of those foods. Your blood test will show how thin the blood is and will tell you if you are eating too many vitamin K foods.
Medicines other than Coumadin work well in preventing clot formation in people with atrial fibrillation. Pradaxa (dabigatran) is one of those medicines. It's more expensive than Coumadin. You don't need to have your blood checked regularly, as you do when using Coumadin. No dietary restrictions are needed. I'm sure you've seen the advertisements from lawyers who are looking for incidences of serious bleeding stemming from the use of Pradaxa. It is a complication. No antidote exists for Pradaxa in a patient who's bleeding. However, fresh frozen plasma appears to contain bleeding on an emergency basis. Another similar drug is Xarelto (rivaroxaban). Your doctor has to guide you in using either of these medicines.
DEAR DRS. DONOHUE AND ROACH: My husband and I are both in our 90s and would like to know the signs of dehydration. -- R.B.
ANSWER: The signs of dehydration are not as apparent in older people as they are in younger ones. For instance, older people tend to have dry mouths even when they have been taking adequate amounts of fluid. Dry mouth, therefore, isn't a reliable indicator of hydration. Older people don't conserve fluid as well as younger people. That's one reason why they dry out faster.
Weakness, dizziness, lightheadedness and headache are some of the signs of dehydration that persist in older ages. Urine color is helpful in determining hydration. Pale-yellow or colorless urine indicates good hydration. Dark-yellow urine is a sign that the body is drying out.
When weather is hot, it's wise for older individuals to drink more fluid than they usually do.
DEAR DRS. DONOHUE AND ROACH: I had a kidney stone years ago, but none since. I drink lots of water. I buy it in the supermarket and only buy distilled water, water without minerals. I was never told the composition of my kidney stone. I do drink other water when it is served to me. -- G.G.
ANSWER: You're right on the mark. The best way to prevent a recurrence of kidney stones is to keep well-hydrated. That means taking in 2 to 2.5 liters of fluid a day. That's a little more than 2 to 2.5 quarts of fluid. Water is excellent. You don't really need distilled water. If you like it, stick with it. And all that fluid can be any liquid, even coffee and tea.
It's also a good idea to reduce salt intake. Salt encourages the passage of calcium into the urine. The most common kinds of kidney stones are calcium phosphate and calcium oxalate.
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Drs. Donohue and Roach regret that they are unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may write the doctors or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers also may order health newsletters from www.rbmamall.com.
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